Provider Demographics
NPI:1811145097
Name:MACWILLIAM, BRIANA (LCAT)
Entity type:Individual
Prefix:MS
First Name:BRIANA
Middle Name:
Last Name:MACWILLIAM
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 E 92ND ST APT 4B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-5481
Mailing Address - Country:US
Mailing Address - Phone:646-651-8141
Mailing Address - Fax:
Practice Address - Street 1:313 E 92ND ST
Practice Address - Street 2:4B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-5482
Practice Address - Country:US
Practice Address - Phone:646-651-8141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-30
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001185-1221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist